Client Identity Form

Client Identity Form and Business Services Agreement

This Agreement is entered into between Client Name: and Service Provider Name: (each a "Party" and together the "Parties").

Recitals

WHEREAS, Client seeks to retain Provider to perform certain business services, and Provider has the requisite experience and capacity to provide those services in accordance with the terms set forth in this Agreement;

WHEREAS, as a condition to commencing services, Provider requires verified identity, contact and ownership information from Client to satisfy regulatory, contractual and risk-management obligations; and

WHEREAS, the Parties desire to set forth the scope, payment, confidentiality and other terms under which Provider will perform services for Client.

Client Identity Details

Individual Corporation LLC Partnership Trust Other

ID Type:    Number:    Issuing State/Country:

Scope of Work

Provider will perform the services described below in a professional and workmanlike manner consistent with industry standards. Specific tasks, deliverables and timelines are to be set forth as follows:

Payment Terms

Client shall pay Provider the fees for services as set forth below. Unless otherwise stated, all amounts are in lawful currency and payable in accordance with the schedule specified.

Late Payment: Amounts not paid when due shall accrue interest at , subject to a minimum late charge of . Client shall also be responsible for collection costs and attorneys' fees incurred by Provider in enforcing payment.

Term and Termination

This Agreement commences on Start Date: and continues until End Date: unless earlier terminated in accordance with this section.

Either Party may terminate for convenience upon providing written notice at least days prior to the effective date of termination. Either Party may terminate immediately for material breach if the breaching Party fails to cure within thirty (30) days after written notice of such breach.

Confidentiality

Each Party shall treat all non-public information disclosed by the other Party related to business operations, technical data, customer information, pricing and other proprietary matters as Confidential Information. Confidential Information shall not be disclosed to third parties and shall be used solely to perform obligations under this Agreement. The confidentiality obligations shall survive termination for a period of five (5) years, except where a longer period is required by applicable law.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to its conflict of law provisions.

Representations and Certification

Client represents and warrants that all identity, ownership and contact information provided in this form is true, complete and correct to the best of Client's knowledge. Client acknowledges that Provider will rely upon the accuracy of such information in performing services and complying with applicable legal and regulatory obligations.

Client Certification: By checking this box Client certifies, under penalty of perjury, that the information provided herein is accurate and complete.

Entire Agreement

This Agreement, together with any attachments or appendices executed by the Parties and the identity information supplied in this form, constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior negotiations, representations, agreements and understandings, whether written or oral.

Notices

All notices required or permitted hereunder shall be in writing and delivered to the contact information provided above or to such other address as either Party designates in writing.

Sign Now